Reporting Clinical Significance in Hip Arthroscopy: Where Are We Now?

Abstract

Background Although p values are standard for reporting statistical significance of patient-reported outcome measures (PROMs), the shift toward clinically important outcome values, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB), necessitates re-evaluation of the current literature. Questions/Purposes We sought to answer two questions regarding studies on primary hip arthroscopy performed for the treatment of femoroacetabular impingement syndrome (FAIS). (1) Do such studies reporting statistical significance on common PROMs meet published MCID/SCB thresholds? (2) What proportion of such studies report both statistical and clinical significance? Methods We identified four papers published in two journals defining MCID/SCB values on the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-Sport), international Hip Outcome Tool (iHOT-33), and its short version (iHOT-12) for different groups of FAIS patients undergoing hip arthroscopy. We reviewed these two journals from the dates of publication to the present to identify papers reporting changes in post-operative PROMs. The difference in pre- and post-operative scores on each PROM was calculated and compared to MCID/SCB thresholds. Results Twelve studies were included. Ten studies (83%) evaluated mHHS (90% met MCID, 50% met SCB), seven (58%) evaluated HOS-ADL (100% met MCID/SCB) and HOS-Sport (100% met MCID, 57% met SCB), and one (8%) evaluated iHOT-33 (met MCID/SCB) and iHOT-12 (met MCID). Most studies met MCID and SCB at both 1- and 2-year timepoints. Of the studies evaluated, 50% reported clinical relevance. Conclusions Nearly all studies evaluated met MCID, while fewer met SCB. Only half discussed these clinical measures. It is proposed that all future studies report both statistical and clinical significance as standard best practice.

Postoperative weight-bearing restrictions and rehabilitation protocols after hip arthroscopy for femoroacetabular impingement: a systematic review

“…A secondary objective of this review was to evaluate outcome reporting and attempt to delineate the most relevant clinical outcome PROMs. Although eight unique PROMs were identified, 83% of studies included the mHHS, which is consistent with the prior literature, suggesting that it is the most commonly used PROM following hip arthroscopy [ 19 , 49 , 50 ]. This suggests that PROM usage in hip arthroscopy is fairly homogenous, compared, for example, to PROM use in the shoulder where there are 19 commonly used PROMs, with no one used in more than 27% of studies [ 51 ].…”

Most Elite Athletes Who Underwent Hip Arthroscopy for Femoroacetabular Impingement Syndrome Did Not Return to the Same Level of Sport, but the Majority Were Satisfied With the Outcome of Surgery

“…In recent years, efforts to define improvements in outcomes for patients have been increasing. 41 These outcomes include the MCID and PASS and should surely be the benchmark for treatment evaluation. However, it is important to acknowledge the results for the HAGOS and iHOT-12 score.…”

Low Back Pain, Psychiatric Disorders, and a Combination of Both Negatively Affect Hip Arthroscopy Outcomes in Servicemembers

“…23,25 Similar systematic reviews have also reported that >90% of hip arthroscopy outcome studies achieved the MCID and SCB on the HOS but have noted that only 25% achieved the PASS. 18,30 Of the hip arthroscopy outcome studies in servicemembers, only 2 have utilized validated nonarthritic outcome scores, but they have not analyzed these outcomes in terms of clinically meaningful benefits. A randomized controlled trial of US servicemembers treated with either arthroscopic surgery or physical therapy for FAI demonstrated significant improvements among surgically treated patients at 2 years on the 33-item International Hip Outcome Tool and HOS-ADL but not on the HOS-S. 19 A prospective study of British servicemembers treated with hip arthroscopy for FAI reported a significantly improved NAHS at 1 year.…”